r e V i e W illness-induced changes in thyroid hormone metabolism: focus on the tissue level J. Kwakkel*, E. Fliers, A. Boelen Department of Endocrinology & Metabolism, Academic Medical Center, University of Amsterdam, the Netherlands, *corresponding author: tel.: +31 (0)20-566 67 01, fax: +31 (0)20-691 76 82, e-mail:
[email protected] a b s t r a C t during illness changes in thyroid hormone metabolism ring and the outer (tyrosyl) ring of T4 can be deiodinated, occur, collectively known as the non-thyroidal illness ultimately leading to the formation of 3,3’-di-iodothyronine syndrome (NTIS). NTIS is characterised by low serum (T2) (figure 1). thyroid hormone levels without the expected rise in serum thyroid-stimulating hormone, indicating a major change in thyroid hormone feedback regulation. recent studies n o n - t H yroidal illness syndro M e have made clear that during NTIS differential changes in thyroid hormone metabolism occur in various tissues, the During illness many aspects of thyroid hormone net effect of which may be either activation or inhibition of metabolism change, collectively known as the thyroid hormone action. in this review we discuss systemic non-thyroidal illness syndrome (NTIS). The hallmark of and local changes in thyroid hormone metabolism during NTIS is decreased serum thyroid hormone levels without illness, highlighting their physiological implications in an increase in TSH and TRH expression, indicating terms of disease course. the absence of negative feedback regulation. This may represent a useful adaptation of the body to counteract excessive catabolism observed during illness and can be K e y W o r d s viewed as a part of the acute phase response.4 However, especially during prolonged critical illness in the ICU Deiodinase, inflammation, non-thyroidal illness syndrome, setting NTIS may be maladaptative.5 thyroid hormone figure 1.